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Development of an EHR across Somerset

Neil Stevens

Director of Informatics

16th November 2011

Neil Stevens

Director, Neil Stevens Consulting

16th November 2011

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Why am I here?• Breadth and depth of experience in

implementing IT systems in healthcare• Some great successes• Some significant failures• If it doesn’t kill you it makes you stronger• Post Cerner (NPFIT) – career still intact!• Hope to provoke thought and lively

discussion• Will tell it how it is

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HISI 2006 - feedback

It was a very rare thing – an Englishman who tells

the truth

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HISI 2006• MH EPR in place already• Somerset Cancer Register (18 sites)• Choose and Book (72%)• Ambitious future plans for Somerset

– RIS/PACS– Order Communications – Summary Care records– NCRS for 2 Acute trusts and 15 community

hospitals

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The NHS in Somerset• Taunton and Somerset NHS FT - 700

beds

• Yeovil District Hospital NHS FT - 400 beds

• Somerset Partnership NHS FT - 40 sites plus 15 Community Hospitals

• NHS Somerset - 80 GP practices

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Somerset Health Informatics

The Somerset Health Informatics Service aims to provide a responsive cost-effective and first-class services to all our customers, which enables IT systems and solutions to support and enhance the delivery of high-quality

healthcare across Somerset.

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Somerset Health Informatics• Programme and Project Management• Application Support• Application and Interface Development• Business Services• Training• IT Development and Support• IT Service Desk• Testing• Telecommunications• Data Management and Processing• IM&T Procurement• IT Security and IG support

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The best laid plans…• NCRS was expected to be delivered (x2)

in early 2006 – Fujitsu and IDX• Then early 2007 with Fujitsu and Cerner• Cerner Millennium went live in West

Somerset 15th December 2007• This was the best (and last)

implementation under the Fujitsu contract before termination in May 2008

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Lowlights• 18 go-live dates• Significant credibility issues• Repeated training of same staff• Significant pressure to stick to dates• Personal and organisational stress• Inconsistent engagement• No programme gateway controls• Limited access to Cerner resources

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Lowlights• Staff not released to support system

configuration and change process• Choose and Book – Direct booking• System used to replicate ‘as-is’ processes• Implementation in parallel with FT bid and

18ww early adopter• Fujitsu departure led to 2-year delay to

programme• How much time and money we wasted!

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Highlights• Excellent Fujitsu staff on site• Programme Director role• We changed the rules!• Gateway controls were introduced• Mouse mats, Post-it notes, Pens,

Lanyards• eLearning• Cutover arrangements• Fun!

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Lessons Learnt• Insist on Gateway controls• Need good clinical engagement• Executive leadership essential• DIP was over-ambitious• Lack of access to Cerner staff• Testing on older versions of software• Insufficient regression testing• Training in parallel with testing• Workarounds developed too late

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Challenges• Connecting for Health• Commercial drivers difficult• Delivery of programme vs the ‘day job’• Need for basic IT literacy for some staff• Technical implementation vs ‘how my job

will change’• Scale of the IT-enabled change

programme• Communication

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Framework for success?

The key issue with this Programme that the Board needs to recognise is that it is not just an IT Programme. It is an IT-enabled

change programme and the NHS needs to pay full attention to both IT delivery and

implementation of the transformation that IT makes possible

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Framework for success?• Early engagement with users• Senior sponsorship, clinical leadership• Understand the desired outputs• Appropriate access to supplier staff• Do not be afraid to escalate• Appropriate delivery of training for the end

users• Insist on controlled project gateways• Keep it fun!

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So where is EHR?• Mental Health – paperless (Rio)• Acute – Cerner Millennium and HP/EDS• Community Hospitals – as Acute + SADIE• Primary Care – well established GP

systems• Investment in Integration Solution (Mirth)• Consideration of Clinical Portal Solutions• Summary Care Record• Spine connectivity

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And finally……

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Any Questions?

neil@neilstevensconsulting.com

www.neilstevensconsulting.com

07806 664603